I love this book. It’s had some stick, and there’s some bits I don’t like but it’s a rollicking read for anyone who cares about women’s health. Holly Grigg-Spall has many completely valid reasons for mistrusting the pill, reasons that should be heard, not dismissed as the paranoid ramblings of a conspiracy theorist. Just check out the All trials campaign if you’re sceptical.
Yes not all references are included, and there's some bias to the arguments. And some of the sources are anecdotes and online forums rather than Randomised Controlled Trials, but as Ben Goldacre (the evidence-based medicine guru) says “Don’t dismiss anecdotal evidence, it can be the canary in the cage”.
Holly Grigg-Spall’s own experiences of both the pill and of coming off the pill are very striking. The pill left her feeling depressed and paranoid, and with zero sex drive but on the upside (?) she had clear skin, bigger boobs and was a few pounds lighter. Coming off the pill for her initially meant acne and greasy hair - fairly common withdrawal side-effects – not things that help you to feel good about yourself. Though at least she tells us that acne can be a result of rising testosterone levels, which is in turn linked to sex drive – a potentially cheering thought for anyone who gets spots, up to a point.
There are some great points made about the way that hormonal contraception is sold as a "choice", but how that choice is often made well before we get anywhere near a doctor's surgery or family planning clinic. Women get the message from all sides that being responsible means putting aside all worries about risks or side effects and simply taking our medicine (for decades). Thanks to all this, it doesn't matter that natural family planning/fertility awareness is on the fpa list of contraceptive options (p6 - final option) most women don't consider it, and if they do then some dismissive words from a health professional will be enough to put them off.
It is also suggested that hormonal contraception is too quickly prescribed as an antidote to painful periods and acne for teenagers. This means it becomes a part of women's lives without them thinking about their choice in any depth. Hormonal contraception may anyway not be a great contraceptive option as it might put people at risk of sexually transmitted infections. If you feel safe from pregnancy then it’s more likely that you will skip using a condom, no matter how many times you are told.
All this sounds fairly reasonable to me. The part I find harder to handle is Holly Grigg-Spall's argument that work to improve contraception in poorer countries is all about population control. Selfish rich people maintaining their own resource-hungry lifestyles by controlling the world's population of poor people. This seems a harsh judgement, access to contraception is a pretty fundamental need for everyone, although it's worth saying that no one should be forced to use any kind of contraception. She also makes the alarming claim that hormonal contraception increases the risk of HIV and AIDS - primarily due to drug interactions, rather than condoms not being used. A recent statement from WHO says that while hormonal contraception in general seems not to put people at risk of HIV, the evidence over injectable contraception and HIV acquisition is unclear and that "further research on the the relationship between hormonal contraception and HIV is essential", so it's an important issue to monitor, especially as condom use in India has declined by 50 per cent over the last 6 years.
Holly Griggs-Spall isn’t completely anti-pill, she appreciates that it is a great (and hard-won) option. She just feels that women are let down if the only ones listening to concerns about the pill are those who are anti-contraception. I think she deserves a hearing. You can buy a copy of Sweetening the Pill here.